Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
Anika L Hines, Debra Roter, Bri K Ghods Dinoso and 3 others
PMID 28779910WHAT IT FOUND
Most depression treatment discussions with African-American patients missed informed decision-making criteria, especially risks and benefits.
Patient-centered topics helped trust and respect in counseling, but in low-patient-centered visits, adding them to medication decisions actually lowered patient trust.
Key findings
01Only 9% of decisions met complete informed decision-making criteria, with risks and benefits discussed in just 15% of cases.
02In visits with low overall patient-centeredness, discussing patient-centered elements during medication decisions was associated with lower patient trust and negative clinician ratings.
03In the same low-patient-centered context, patient-centered discussion during counseling decisions improved patient ratings of trust and respect.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small (76 patients), limiting the reliability of estimates and statistical power. Participants may differ from those who refused, introducing selection bias. The study was conducted in a single geographic region, so results may not generalize to other areas. Data was collected from a single visit, missing communication patterns over time. Patient ratings were collected up to two weeks later, which may introduce recall bias.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that adding patient-centered conversation always improves outcomes. The study found that in visits lacking overall patient-centeredness, discussing patient-centered topics during medication decisions was associated with lower patient trust, whereas the same approach in counseling decisions improved trust.